Faith Warriors Registration Form 24-25

Faith Warriors Class Registration

Classes begin Wednesday September 3rd, 2025 1694 Hwy 152 | Osceola, IA 50213
Student Name:*

First NameLast Name
Grade 25-26 school year:*
Age:*
Student DOB:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name:*
Primary Phone Number:*
Please enter a valid phone number.
Parent/Guardian Email Address:
example@example.com
Emergency Contact:*
Emergency Phone Number:*
Please enter a valid phone number.
Child Lives With:*
Allergies or other medical conditions/concerns:*
Additional person(s) who may pick up child:*
Any person(s) NOT allowed to pick up child:
Note: Any person unfamiliar to us will be required to show proof of identification. Under NO circumstance will the child be released to anyone other than those listed above without WRITTEN permission from the parent.

Notice:

By participating in this program, you acknowledge and agree that photos and/or videos may be taken during program activities. These images may be used for internal purposes as well as promotional materials, including but not limited to social media, printed materials, and our website.

If you do not wish for your child to be photographed or have your image used, you must provide direct notice to the program coordinator prior to participation.

Thank you for helping us share the joy of our program!
Parent/Legal Guardian Print Name:*
Should be Empty:

Faith Warriors Class Registration